Can Republicans wreck Medicaid through block grants?

A brilliant article–by me–covers much wrong with Medicaid block grants:

Every politician knows that you can’t touch Medicare without first gaining the permission of America’s seniors. Yet Republicans now seek to upend the basic structure of Medicaid, with surprisingly little discussion, let alone any effort to determine how low-income adults and children, the aged, and the disabled feel about these critical changes to their health coverage.

This battle doesn’t get the political attention it deserves because the details become boring and technical, and because the design of Medicaid apparently affects other people – by which we mean poor people – who presumably should be grateful for what they get.

Speaker of the House Paul Ryan and others would convert Medicaid to a block grant. Before inauguration, President-elect Trump announced his support for this approach. Rep. Tom Price, the Trump Administration’s nominee to run the Department of Health and Human Services, reiterated that position in his confirmation hearings.

On last Sunday’s talk shows, White House counselor Kellyanne Conway suggested that converting Medicaid to a block grant would ensure that “those who are closest to the people in need will be administering” the program.

As with everything in Trump-era health policy, we haven’t seen the fine print. We don’t know how the block grants would be financed, how they would impact states or low-income citizens. The details matter, and they won’t be good….

More here, at

Unrelated picture below:

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect,, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

3 thoughts on “Can Republicans wreck Medicaid through block grants?”

  1. Is it a good thing that seniors can veto changes to Medicare, which is a huge intergenerational wealth transfer from the currently struggling young to the relatively well off old?

    1. Seniors exercise their veto by voting. Young people now outnumber them, if they vote in large numbers – particularly in the mid-terms! – policies will be more favorable to their interests. Since Republicans hate Medicare/Medicaid (for anyone but their superannuated, Fox-addled base), and love, love, love, tax cuts for the wealthy, I would suggest that young folks vote for the party that wants to maintain Medicare/Medicaid and Social Security, while also easing the burden on working people, young and old, through tax credits, child care allowances, student loan reform, universal healthcare, minimum wage and labor protections. Oh, and since we're talking about young folks, on the off-chance that there are any who are as worried about the impact of budget deficits in the far off future as are today's plutocrats who will be long dead when the bills come due, they should vote for the party that reduces the deficit when it holds the presidency, through tax hikes and spending discipline, rather than the party that ravages the public fisc to shower the super-wealthy with tax cuts while immiserating the poor and middle-class.

  2. The hoopla over having a crazy guy as president and a race warrior as his puppeteer has for the moment overshadowed the usual rifts in congress, which will determine this kind of stuff. As long as the nutbar caucus tail keeps wagging the GOP-majority dog, I think the usual considerations about how soon this would get people thrown out of office don't apply. You can't really say — even in private, given the current ubiquity of leaks — "But we can't pass something this crazy, there's nobody to veto it and take the blame."

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